This inspection took place on 2 and 3 January 2019 and was unannounced.

Oaktree Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Oaktree Court is registered to provide accommodation for 56 older people who require nursing and personal care. The home has a specialist unit for people living with dementia called the Somerset Suite. At the time of the inspection there were 43 people living at the home.

The service is divided into three units, the ground floor and second floor accommodated people who required general nursing care or residential care. The third-floor accommodated people who have a dementia. All bedrooms are for single occupancy and are fitted with en-suite facilities. The service is staffed 24 hours a day and registered nurses are available for people with nursing needs.

At the last inspection we rated the service good. At this inspection we found the evidence did not continue to support the rating of good and there was evidence that showed serious risks or concerns. We have therefore changed the rating to requires improvement.

This is because, whilst people were supported to have maximum choice and control over their lives, and staff supported them in the least restrictive way possible; On the day of the inspection the policies and systems within the home did not fully support this practice and current governance arrangements had not consistently identified shortfalls within the service. For example, people’s medicines were not managed safely or administered appropriately and risk assessments were not always completed to ensure people remained safe in the home.

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The service had a home manager but there was no manager registered with the Care Quality Commission. Oaktree Court has not had a registered manager since March 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the time of the inspection the home manager was not available and we were told they would be leaving the company on 6 January 2019. The deputy manager told us the provider had recruited a new home manager and they were due to start on the 7 January 2019.

Training wasn’t always effective and staff did not have specialist training in areas such as managing oxygen and supporting people with Parkinson’s even though there was a need for this within the home. However, there were sufficient numbers of staff available, and recruitment processes minimised the risk of employing unsuitable staff.

The provider had systems in place to assess people’s needs and choices and people. People gave consent to care and those that did not have the capacity to give consent had mental capacity assessments completed and decisions in their best interest were made.

Staff were aware of the reporting process for any accidents or incidents. And people knew how raise a complaint if they were unhappy with the care provided.

The provider had systems in place to assess people’s needs and choices before they moved into Oaktree Court. People told us they felt safe living at Oaktree Court. Staff protected people by following good infection control practices. There was an extensive activity program the provider was very proud of that encouraged people to remain as independent as possible.

The provider had identified Oaktree Court needed a stronger management structure to support its development. As a result, the provider had recruited a business manager who had been in post for three months at the time of the inspection and an operational manager who had been in post for three weeks. Both the operational manager and the business manager supported the deputy manager, who was a

This inspection was unannounced and took place on 6 July 2016.

Oaktree Court is registered to provide accommodation for 56 older people who require nursing and personal care. The home has a specialist dementia unit called the Somerset Suite.

The last inspection of the home was carried out on 30 October 2013. No concerns were identified with the care being provided to people at that inspection.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had managed the home for a number of years and had a good knowledge of the needs of the people who used the service. Everyone described the manager as open and approachable. People and staff said they felt able to discuss any issues with them.

People living at Oaktree Court told us they were very happy with the care and support provided. They said the manager and staff cared about their personal needs and preferences. One visiting relative said, “As soon as we walked through the door we knew this was a special home”. One person said, “I have made some lovely friends since moving here. Staff are 100% excellent”.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Staff took time to talk with people during the day and call bells were answered promptly. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe were held in people’s care plans.

People were supported to take part in stimulating and meaningful activities. Some people belonged to Oaktree Court Bowling group. The service had recently purchased a new mini bus and employed a new driver. People enjoyed a full programme of activities in the home. One person said, “Never a dull moment, plenty to do if you want to join in. If you want to opt out they don’t start forcing you.” On the day of the inspection we saw people enjoying a range of activities, including a trip out for coffee and cake.

Staff monitored people’s health and ensured people were seen and treated for any urgent or long term health conditions. We observed a heads of department meeting where people’s needs and any changes to people needs were discussed and a plan of action was implemented.

The mealtime experiences were seen as positive for people living in the home. Throughout the day, snacks and hot and cold drinks were offered to all. If people wished to receive alcoholic beverages, these were provided. One person told us “There is always fruit and drinks available throughout the day, in the afternoon we have homemade cakes. It is all very pleasant”.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely and medicine administration was recorded on an electronic system.

People were supported to access external health professionals, when required, to maintain their health and wellbeing.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found :

Is the service safe?

People who lived in the home said they felt safe and they were treated well by the staff. One person said “Staff are very good. We are looked after very well.” Another person said “I would complain if I was not happy. Things do get changed.” A relative told us they were generally very pleased with the care in the home but when they had raised issues “things had been quickly sorted out.”

The service identified, assessed and managed risks to the health, safety and welfare of people. People’s care plans contained individual risk assessments and plans to minimise these risks. We saw staffing levels were sufficient to reduce the potential risk of harm for people in the home. Staff carried out regular in-house checks of the environment, fire safety systems and other risk areas. Specialist contractors were employed to check and maintain essential safety protection systems such as those for fire detection and other equipment.

Arrangements were in place to deal with foreseeable emergencies. We saw records of regular fire drills and an emergency evacuation plan. Nurses were on duty 24 hours a day. Regular calls were made to local GP practice as and when needed.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager said they had not needed to submit any Deprivation of Liberty Safeguards applications but they knew about the procedures to follow if an application was ever needed.

Is the service effective?

People were supported to live their lives in a way that suited their personal needs and preferences. This helped promote effective care outcomes and a good quality of life for the people who lived in the home. People told us they were happy with the care and support they received. One person said “It is very comfortable. I couldn’t complain about anything. I normally get up at 6:30. That is my choice.” We heard people could “come and go” as they pleased.

Care plans and discussions with people who lived in the home showed people’s care needs had been assessed and appropriate support was provided. Staff we spoke with had a clear understanding of each person’s individual support needs and how they should be met. There were enough qualified, skilled and experienced staff to meet people’s needs. People also had access to specialist staff when needed.

People were supported in promoting their independence and community involvement whenever possible. Some people were able to go on regular trips. One recent trip had been to a local village for fish and chips. We heard “It is good to get out.”

Is the service caring?

We observed staff treated each individual with dignity and respect. They spoke to people in a friendly and caring manner and addressed people by their preferred names.

Staff respected people’s privacy and did not enter people’s rooms without knocking and asking their permission to enter. Each person had their own individual bedroom with an en-suite bathroom which helped to maintain their privacy and dignity.

Staff supported people to make their own daily living choices and to be as independent as they were able to be. This helped promote people’s self-esteem and gave them a sense of achievement.

We observed people’s rooms contained individualised furnishings and personal belongings. This helped people feel more at home and ensured their rooms were individualised to suit each person’s tastes.

Is the service responsive?

The service was responsive to people’s needs. People's needs were assessed and their care was planned and delivered in line with their individual needs and personal preferences. Staff had a clear understanding of each person’s support needs and how they should be met. For example, a care plan for a person living in the Somerset Suite gave information about the ways they communicated their needs and the things that might upset them.

People told us they were involved in making decisions about all aspects of their care. One person said “I can pretty much do as I want”. People were consulted about menu choices and were free to have their own alternative meal if they wished.

People could choose where and how to spend their time. They were free to move around the home and the grounds as they wished. They could choose to spend time on their own in their rooms or chat with each other or the staff in the various communal areas.

Is the service well led?

The home manager had been in post for a month when we inspected the home. They had experience of managing other care homes and were very positive about their post at Oaktree Court. They were not yet registered with us but were planning to commence the process in the near future. We discussed with them the importance of the home having a registered manager in place.

The manager was getting to know the home and had arranged to hold meetings for people who lived there and their relatives. The manager told us they had had introduced short daily meetings at ten o’clock to keep senior staff aware of changes and events in the home.

There was a staffing structure in place with clear lines of reporting and accountability. Staff were very positive about working at the home and told us they were able to report any issues directly to the manager and were confident appropriate action would be taken.

This inspection was carried out in response to information received by the Care Quality Commission from a whistle blower, local social services and the district nursing team. Concerns were raised about the training for new staff on manual handling, staffing levels, care and support provided and gaps in the communication of important information between shifts. District nurses raised concerns about the quality of nursing care provided to some people.

When we visited the home there were 47 people living there. A peripatetic manager was in charge of the home because of long term sickness of the registered manager and the deputy manager was providing nurse cover on that day. Two senior representatives of the provider also visited the home during the inspection. We met and spoke with five people who lived in the home, we observed care and support provided to people, and we spoke in depth to one visitor. We spoke with seven staff. We looked at documents relating to people’s care and support. We reviewed information in regard to staffing and training. We looked at records relating to the management of the service.

We found there were some improvements required in the way the service supported people for their nursing and personal care. There were aspects of communication between staff both written and verbal that had the potential to put people at risk of not receiving the support they needed. We found at times the number and qualifications of staff working in the home varied and did not meet people’s needs. However, we saw that the provider was actively working to improve this.

This was a planned inspection to check compliance. During this inspection we looked at care records for seven people; spoke with six people who used the service, eight staff including the deputy manager and one visitor. At the time of the inspection visit the home was almost fully occupied. Eight people were resident in the new 12 bedded dementia floor of the home.

The people we spoke with told us that they received the care and support they needed. One person said that moving to the newly refurbished floor of the home was, “Wonderful, really like it here, very nice.” A visitor told us that the person they cared for had settled well and “His anxiety levels are much less.” People told us that the food and menus provided in the home were, “satisfactory” and there was always a variety or alternatives available.

People told us that there had been a number of (agency) staff in the home that they did not know and they had to explain what support they needed. Other comments about the staff team were, “Very nice staff,” and “no worries they always speak to me when I come in.” One person told us “Some staff are better than others, some always pop their head in to my room to speak to me, others walk past and do not.”

We found the provider had taken action to increase the staffing levels and had employed agency staff to ensure that sufficient support was provided until permanent staff recruited. Records kept in the home were accurate and kept securely.

This inspection visit was carried out to check compliance in relation to concerns found at a responsive inspection visit in October 2012. These concerns were about the care and welfare of people who use the service, management of medicines and records.

We looked at care records for six people; spoke with four people who used the service, seven staff including the manager and three visitors. At the time of the inspection visit there were 35 people resident in the home. 12 bedrooms were in the process of refurbishment.

The people we spoke with during this inspection visit said they were very happy with the support they received. One person told us,” Going well, they look after me.” They also said their health needs were met and the support they had from staff was good. A relative told us their opinion of the home was,” Absolutely lovely. Staff are wonderful and there is a homely feel to the home. I always enjoy coming to visit.” We were told by a visitor about a recent reminiscence game they had witnessed “It was excellent and there was lot of laughter. Staff, visitors and residents together.”

We found that people received the care and support they needed, including the medicines they required. We also saw that people’s personal records were accurate and fit for purpose.

Oaktree Court although registered for 56 people, at the time of the inspection 37 of the beds were occupied. This was due to a refurbishment programme that had just been completed in one area of the home. This inspection was a scheduled inspection. However, prior to the visit we were provided with information from both the home and social services about issues that affected people’s welfare. These concerns were; a higher than expected incidents of pressures sores to people living there had occurred, medication records were not always completed appropriately,and new staff did not get the support they needed when the commenced working in the home.

During our visit we spoke with six people who used the service and four relatives who were present at the time of the inspection visit. We also spoke with eight staff including care workers, a registered nurse, domestic staff and the newly appointed home manager.

People told us that they thought they or their relative was looked after well and they received the support that they needed. They used phrases such as, “Very Good”, “It’s alright” and “Going very well.” One relative told us that they had observed that the care provided to the person they supported had “been fine” and that they had every confidence in the staff meeting the person’s needs. We were also told that they had been included in reviews of planned care and were able to participate in the decision making about the support that was to be provided.

We observed people were dressed appropriately and they had been supported to maintain their hair, nails and personal care. Where people remained in bed they appeared to be comfortable and measures had been put in place, such as bed rails to keep them safe. We saw that people were nursed in specialist beds and with mattresses and aids that reduced the risk of pressure injuries.

People told us that they felt safe living in the home. One relative told us that they were confident to go away on holiday knowing that the person they cared for was safe. Staff we spoke with were able to appropriately describe what actions they would take if they thought that peoples safety and well being was at risk. This was in regard to safeguarding people from possible abuse or harm.

We found that staff were recording the administration of medications appropriately. There were areas of recording certain medication administrations that could be improved. These gaps in recording had the potential to affect a very small number of people living in the home and had already been identified as an area of improvement that staff were in the process of carrying out.

People told us that there were usually enough staff on duty and when they called for assistance from staff they came quickly. People told us that they had observed that staff were kept busy with helping people but remained friendly and spoke cheerfully to them. One person said, “staff really good – never stop (working).”

We visited Oaktree Court in response to concerning information received about the services provided to people living in the home. These concerns were around the delays in people receiving the care and support they needed and about medication administration practices.

We visited the home over two days and reviewed 12 care records, medication administration records, controlled drugs records, and medicine disposal records. We also reviewed other records for the administration and management of the service. We spoke with four people who used the service and the staff on duty. We also spoke with a visiting medical practitioner. At the time of our visit there were 37 people living in the home.

We found there were three areas that significantly put people at risk from not receiving the support and treatment they needed. These were in regard to the medication administration practices, the record keeping carried out in the home, and for the care and welfare of people who used the service.

People we spoke to were happy with how their medicines were looked after. However, we were told by one person that a particular shampoo they were prescribed was not used. Another person told us that a cream they were prescribed was usually applied morning and night but very rarely during the day.